完全腹膜外补片植入术治疗腹股沟复合疝42例

目的探讨完全腹膜外补片植入术（totally extraperitoneal technique,TEP）治疗腹股沟复合疝的临床疗效。方法2004年7月～2008年6月应用TEP治疗42例腹股沟复合疝,其中双侧斜疝18例,单侧直疝、斜疝8例,一侧斜疝、另侧直疝5例,双侧直疝4例,双侧斜疝、一侧直疝3例,双侧直疝、一侧斜疝2例,同侧斜疝、股疝1例,双侧直疝、斜疝1例。脐下15mm切口达腹白线,切开10mm,镜头进入腹膜外间隙进行分离。直视下脐下5cm旁开5cm置入2个5mm trocar。建立腹膜外气腹,下达耻骨后间隙,外至髂前上棘,还纳复合疝各疝囊,使精索壁化。聚丙烯平片覆盖患侧肌耻骨孔、直疝三角,疝螺旋修补钉固定补片。结果42例均完成TEP,手术时间85～165min,平均107.3min;术中出血量10～20ml。术中均有阴囊气肿,术后自行吸收。术后2d内恢复饮食。住院时间7～9d,平均7.6d。42例随访时间3～32个月,平均15.3月,2例直疝复发,5例出现下腹壁轻微感觉异常,无其他并发症发生。结论TEP治疗腹股沟复合疝,安全可靠。

Totally Extraperitoneal Technique for Complex Inguinal Hernia Repair: Report of 42 Cases

Objective To evaluate the clinic efficacy of laparoscopic totally extraperitoneal technique in complex inguinal hernia repair. Methods Totally 42 patients with complex inguinal hernia were repaired by laparoscopic totally extraperitoneal technique in our hospital during July 2004 to June 2008. Among the cases, 18 patients had bilateral indirect inguinal hernia, 8 had unilateral indirect and direct inguinal hernia, 5 suffered from indirect inguinal hernia at one side and direct inguinal hernia in the other side, 4 patients showed bilateral direct inguinal, 3 showed bilateral indirect inguinal hernia and unilateral direct inguinal hernia, 2 had bilateral direct inguinal hernia and unilateral indirect inguinal hernia, 1 patient showed indirect inguinal hernia complicated with femoral hernia at the same side, and 1 patient had indirect and direct inguinal hernia at the both sides. During the operation,a 10-mm incision was made at 15 mm below the umbilicus reaching the Hunter＇s line,to place the laparoscope and separate the extraperitoneal space. Afterwards, two 5-mm trocars were inserted and then extraperitoneal pneumorperitoneum was established involving the retropublic space extending up to the anterior superior spine,so that to return the complex hernias. A polypropylene patch was then used to cover the pubic foramen and Hesselbach triangle. Results TEP was successfully completed in all of the 42 patients with a mean operation time of 85 - 165 min （mean, 107.3 min） and estimated intraoperative blood loss of 10 -20 ml. Scrotum aerocele was detected in all of the cases during the operation. The patients received normal diet in 2 days postoperation. They were discharged from our hospital in 7 to 9 days （mean, 7.6 days）. Follow-up was achieved for 3 to 32 months （mean, 15.3 months） in all of the patients, during the period, 2 patients showed recurrent direct inguinal hernia, and 5 had mild paraesthesia in the lower abdominal wall. Conclusions TEP is safe and effective for complex inguinal hernia.